Rick Altice, MD

Professor of Medicine (Infectious Diseases) and of Epidemiology (Microbial Diseases); Director, Clinical and Community Research; Director, HIV in Prisons Program; Director, Community Health Care Van; Academic Icon Professor of Medicine, University of Malaya-Centre of Excellence for Research in AIDS (CERiA)

Research Summary

My focus of research has broadly been on the interface between infectious diseases and substance use disorders, with additional interests in research in community, criminal justice and clinical care settings. As a clinical epidemiologist, health services and intervention researcher, has created novel programs for the treatment of HIV, HCV, and tuberculosis in vulnerable populations, including injection drug users and prison inmates. Specifically, has been an international leader in research related to adherence to antiretroviral therapy, particularly among HIV+ drug users, and has made considerable inroads into novel approaches using directly administered antiretroviral therapy and other structural interventions to facilitate adherence both nationally and internationally.

I am currently leading a number of studies that bridge the gap between the correctional and community setting, specifically on the use of directly observed antiretroviral therapy and medication-assisted therapy for the treatment of substance use disorders. Current research includes methadone and buprenorphine as primary and secondary HIV prevention, directly administered antiretroviral therapy, peer-driven interventions, secondary prevention among drug users and prisoners, medication-assisted therapies for the treatment of substance use disorders using methadone, buprenorphine and naltrexone. International research projects are currently underway in Malaysia, Indonesia, Ukraine, Russia and Argentina.

Implementation science is a key element of the current research, specifically how and why evidence-based interventions (e.g, HIV treatment, PrEP, HIV Prevention, HCV treatment, opioid agonist therapies) are introduced and scaled to need. Such studies are underway in a number of settings.

Extensive Research Description

Frederick L. Altice is a professor of medicine, epidemiology and public health. He is a clinical epidemiologist and intervention researcher at Yale University School of Medicine. Dr. Altice's primary research examines the relationship between infectious diseases and substance use disorders. His work has also focused on the criminal justice system, examining linkages between the community and correctional settings. Specific topics include; substance use disorders including opioids, stimulants and alcohol use disorders on HIV treatment outcomes and healthcare integration strategies. He has been a pioneer in the creation and evaluation of innovative strategies to engage HIV-infected drug users in care as well as develop strategies to facilitate adherence to antiretroviral medications. He is developing and creating methods to assess health services integration as a means to promote improved health outcomes, especially for HIV, viral hepatitis, tuberculosis, mental illness and substance use disorders. Additionally, his research seeks to understand the relationship of medication-assisted therapies, such as methadone, buprenorphine and extended-release naltrexone and its role in primary and secondary HIV prevention. His research projects extend internationally in the United States, Malaysia, Peru, Ukraine, Russia, Kazakhstan, Azerbaijan and Argentina.

Dr. Altice received his M.D. at Emory University. He is the Academic Icon Professor of Medicine at the University of Malaya in Kuala Lumpur where he conducts research in collaboration with colleagues at the Centre of Excellence on Research in AIDS and the Centre of Addiction Studies. He has been the principal investigator of several projects for the National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Agency, the Health Services Resource Agency's Special Projects of National Significance and Center for Substance Abuse Treatment.

CURRENT STUDIES

Prison Interventions and HIV Prevention Collaboration in Ukraine: To develop and test HIV prevention and treatment interventions using implementation research techniques in the criminal justice system and in several other countries in Eastern Europe and Central Asia (Ukraine, Moldova, Armenia, Georgia, Kyrgyzstan). Funding: NIDA. Principal Investigator: Altice

Integrating Methadone, HIV and TB treatment into Primary Care Settings in Ukraine: This step-wedge, cluster, randomized controlled trial using an implementation science strategy compares quality health indicators for patient randomized to treatment with methadone in addiction specialty care settings (control) with methadone in primary care settings with or without pay-for-performance incentives. Implementation will be provided through Project ECHO and provides a collaborative learning environment to make primary care clinicians competent at treatment with methadone, and provide HIV and TB treatment. Cost-effectiveness analyses included.

Expanding Medication-Assisted Therapies in Ukraine: This implementation science study uses both quantitative and quantitative surveys of PWID and physicians/nurses followed by coaching using the NIATx treatment improvement model to increase entry and retention on OAT.

Project Harapan II: This is a study of HIV/TB infection in prisons in Malaysia to identify the most optimal strategy for screening for TB in this setting, to conduct a RCT of prevention of latent TB infection comparing 26 weeks of daily isoniazid vs 12 weeks of weekly isoniazid/rifapentine, and a RCT of HIV/TB patients with opioid dependence who are transitioning to the community who will be randomized to a preference trial comparing implantable naltrexone vs methadone vs no medication-assisted therapy. Cost-effectiveness and TB prevention modeling will be conducted.

mHealth: Special Project of National Significance: mHEALTH: Medical Home Engagement and Aligning Lifestyles and Transition from Homelessness Description: To create a new innovative model of managing complex HIV+ patients with mental illness and homelessness. Funding: HRSA; Principal Investigator: Altice.

Modeling HIV/HCV Transition Dynamics of Injection Networks of PWID. This study uses data from over 500 PWID and their 2500 individuals in their injection network. Modeling will include identification of the most effective strategy to use treatment as prevention with or without various HIV prevention (OAT / NSP) strategies. Funding: NIDA.Principal Investigator: Altice.

Exploring the Within Prison Risk Environment and HIV Transmission in Kyrgyzstan: This study will use qualitative surveys of opioid dependent prisoners with and without HIV and examine how the risk environment as prisoners transition to the community. Funding: NIDA.Principal Investigator: Meyer (Altice, Co-I).

RECENTLY COMPLETED

Alcohol Pharmacotherapies Among Released Prisoners: Randomized, placebo-controlled trial of depot-naltrexone for HIV+ prisoners with alcohol dependence who are transitioning to the community. Funding: NIAAA. Principal Investigators: Altice and Springer

EnhanceLink: This is a Special Project of National Significance to develop and evaluate evidence-based models for integrating substance abuse treatment and contingency management into a comprehensive jail-release program. The program utilizes buprenorphine treatment as a conduit to care. Funding: HRSA Principal Investigator: Altice

Choices: This program builds on our previous SAMHSA work where we developed the first mobile buprenorphine induction and stabilization program in the country. In this project, we target our buprenorphine expansion for released prisoners with or at risk for HIV/AIDS. We also integrate other evidence-based interventions as part of the expansion and enhancement of services.

Activities

Studies of Alcohol and Drug Use Among MSM in Peru
Lima, Peru (2011 - 2016)

Biobehavioral Surveys, RCTs of XR-NTX among HIV+ MSM with alcohol use disorders and RCTs of early vs late initiation of ART among newly seroconverted MSM. This is a Fogarty International Global Health Equity Scholars site.

HIV, Opioid, Substance abuse, Malaysia
Kuala Lumpur, Malaysia (2010)

Intervention of HIV, Drug Use and the Criminal Justice System in Malaysia

HIV, Tuberculosis and Drug Dependence In Iran
Iran (2009)

This involves three projects: 1. HIV and TB Coinfection Among Drug Users in Iran 2. Treatment for Opioid Dependence Among Individuals with HIV or TB 3. Prisoners and Methadone Maintenance.

Opioid Dependence and HIV in Malaysia
Malaysia (2009)

In 2005, the Malaysian government changed its policies toward substance abuse by implementing syringe exchange programs and methadone maintenance programs. Professor Altice has been a consultant in developing and evaluating the new policies and have since begun several different studies in Malaysia...

Infectious Diseases and Addiction
Kuala Lumpur, Malaysia (2005)

Funded Research Activities with Centre of Excellence in Research on AIDS (CERiA). Projects are extensive and include epidemiological studies with vulnerable populations including prisoners, female sex workers, men who have sex with men and people who inject drugs. Current studies also include...

Since 2005, Professor Altice have trained the physicians on treatment of opioid dependence, HIV and tuberculosis. Specifically, in collaboration with his Ukrainian colleagues, They introduced the first pilot buprenorphine treatment programs in the country. They are now participating in the...

Al-Darraji HA, Kamarulzaman A, Altice FL. Isoniazid preventive therapy in correctional facilities: a systematic review. The International Journal Of Tuberculosis And Lung Disease : The Official Journal Of The International Union Against Tuberculosis And Lung Disease 2012, 16:871-9. 2012

Gupta S, Altice FL. Hepatitis B virus infection in US correctional facilities: a review of diagnosis, management, and public health implications. Journal Of Urban Health : Bulletin Of The New York Academy Of Medicine 2009, 86:263-79. 2009

Copenhaver MM, Bruce RD, Altice FL. Behavioral counseling content for optimizing the use of buprenorphine for treatment of opioid dependence in community-based settings: a review of the empirical evidence. The American Journal Of Drug And Alcohol Abuse 2007, 33:643-54. 2007

Bruce RD, Altice FL. Case series on the safe use of buprenorphine/naloxone in individuals with acute hepatitis C infection and abnormal hepatic liver transaminases. The American Journal Of Drug And Alcohol Abuse 2007, 33:869-74. 2007

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